Surveillance of Transfusion Complications

Surveillance of the blood system is a key tool for ensuring safety of the blood supply. It involves monitoring adverse events so that risks and trends can be identified early and appropriately managed. Related terms are hemovigilance (e.g., France, Canada - Transfusion Transmitted Infection Surveillance System - TTISS), medical-event reporting system for transfusion medicine (MERS-TM, USA), serious hazards of transfusion (SHOT, Britain) and adverse events reporting systems (See Further Reading).

Surveillance can be applied to monitoring adverse events, to include transmissible diseases, accidents and errors, near-misses, transfusion reactions, and any complication of transfusion. Surveillance involves integrating surveillance information on donors and recipients into an integrated database, as well as monitoring international trends that affect blood safety. Surveillance roles exist for hospital transfusion services, CBS, Health Canada.

Surveillance and reporting systems are based on the concept that an important component of preventing adverse events is the careful assessment of their incidence and root causes. To be effective, surveillance systems require a standardized confidential reporting system that avoids under-reporting and includes near misses.

Blood Surveillance

Health Canada has developed a national reporting system which will be used in all Canadian provinces/territories and CBS in 2004. One standardized form will be used to report to hospital transfusion services to CBS, provincial blood offices and Health Canada. The goals of the system are to provide timely information and data to support:

• Assessments of the nature and magnitude of the risks associated with blood transfusion in Canada
• Policy changes for
  - regulation of blood safety
  - preventative and corrective interventions
• Identification of emerging threats to blood safety (enhanced ability via sentinel sites and special studies)
• Identification of interventions to improve transfusion safety and appropriate use of blood and blood products

Implementation

Implementing the system will occur in three stages, each with a different scope:

Short term. The focus will be on adverse reactions to transfusion and the accident and errors that occur in hospitals (See Further Reading).

Intermediate term. Data collection and analysis will be extended to capture reactions to infusion of blood products that occur outside the hospital and establish electronic data linkages.

Long term. The system will capture information on delayed infectious complications to blood and blood products and will include information on the diagnosis, procedure, and indications for transfusion. Note: This is a short term deliverable for studies on high risk populations such as people with hemophilia, recipients of apheresis components, and bone marrow recipients.